GOUT

Question 1

What is gout

Answer 1

form of inflammatory arthritis characterised by raised uric acid concentration in the blood (hyperuricaemia) and the deposition of urate crystals in joints and other tissues

Question 2

what increases the risk of gout

Answer 2

overweight
drink alcohol
have been through the menopause
take medicines such as diuretics (water tablets), or medicines for high blood pressure (such as ACE inhibitors)
have high cholesterol, high blood pressure, kidney problems, osteoarthritis or diabetes
have had surgery or an injury

Question 3

what are lifestyle interventions

Answer 3

Patients with gout and a history of urolithiasis should be advised to ensure adequate daily fluid intake and avoid dehydration.

Alkalinisation of the urine with potassium citrate can be considered in recurrent stone formers.

Question 4

what is used for prevention of gout?

Answer 4

allopurinol or feboxostat

at least 2 to 4 weeks after a gout flare has settled

The initiation or up-titration of urate-lowering therapy may precipitate an acute attack

colchicine should be offered as prophylaxis while the target serum urate level is being reached

Question 5

what used for treatment of acute gout attacks?

Answer 5

colchicine, high doses of an NSAID

short course of an oral corticosteroid.

Question 6

What is benefits and negatives of colchicine?

Answer 6

(-)
narrow therapeutic range and its use is limited by the development of toxicity at higher doses.

(+)
unlike NSAIDs, it does not induce fluid retention;

it can be co-administered with anticoagulants.

Question 7

What are serum target aims?

Answer 7

serum urate level below 360 micromol/litre.

300 micromol/litre for patients with tophi, chronic gouty arthritis, or those who have frequent flares